Abstract
Background. In recent years, the issue of the occurrence of immune remodeling, including the immune cell activation and changes in cytokine secretion, is a subject of considerable debate. According to modern guidelines on the diagnosis and treatment of atrial fibrillation, selection of the strategy to preserve sinus rhythm makes it possible to improve the patients’ long-term outcomes. There are almost no papers focused on assessing the dynamic changes in markers of inflammation when selecting the atrial fibrillation treatment strategy in the modern literature.
Aim. To assess changes in plasma concentration of C-reactive protein (CRP) when selecting the arrhythmia treatment strategy in patients with arterial hypertension (AH) and paroxysmal atrial fibrillation form.
Methods. A total of 62 patients with AH and paroxysmal atrial fibrillation form were included in the pilot single-center prospective study. They were randomized into two groups: group 1 was constituted by 32 patients, who took propafenone (Propanorm) at a daily dose of 450 mg in combination with selective β-blockers to maintain sinus rhythm; group 2 was constituted by 30 patients, who took selective β-blockers only to control the ventricular rate. Plasma CRP levels were determined during the enrollment visit and after 3 months of follow-up.
Results. Throughout the follow-up period, sinus rhythm was preserved in 30 (93.8%) patients of group 1 and 8 (26.6%) patients of group 2 (р=0.012). After 3 months of treatment, a significant decrease in plasma CRP concentration from 5.5 [2.3; 8.7] mg/L to 3.2 [1.2; 6.4] mg/L (р=0.002) was observed on the rhythm control group, while in the ventricular rate control there was no significant CRP decrease – 5.3 [2.8; 7.9] mg/L and 4.3 [2.3; 6.7] mg/L (р=0.0871). Univariate regression analysis has shown that the increase in plasma CRP concentration and left atrial volume has a significant effect on the recurrent paroxysmal arrhythmia in patients with AH and paroxysmal atrial fibrillation form. The CRP level increase of more than 3.0 mg/L increases the chance of developing atrial fibrillation 2.5-fold (AUC – 0.800, odds ratio 2.53, 95% confidence interval 1.56–3.97, p=0.001).
Conclusions. When taking propafenone (Propanorm) at a daily dose of 450 mg, maintaining sinus rhythm contributed to the significant decrease in plasma CRP concentrations in patients with AH and paroxysmal atrial fibrillation form. The CRP level increase of more than 3.0 mg/L increases the risk of recurrent atrial fibrillation 2.5-fold (AUC – 0.800, odds ratio 2.53, 95% confidence interval 1.56–3.97, p=0.001).
Keywords: atrial fibrillation, antiarrhythmic therapy, class IC drugs, propafenone.
For citation:Tarzimanova A.I., Isaeva A.Yu., Samedova E.Sh., Okhtova A.A., Katorozh E.A., Podzolkov V.I. Changes in C-reactive protein levels when choosing different treatment strategies for atrial fibrillation. Clinical review for general practice. 2026; 7 (3): 95–99. DOI: 10.47407/kr2026.7.3.00803
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